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Typical physical examination, chest radiography, and electrocardiography findings in some forms of cyanotic heart disease

Typical physical examination, chest radiography, and electrocardiography findings in some forms of cyanotic heart disease
Diagnosis Physical examination Chest radiography Electrocardiogram Incidence
(per 100,000 live births)*
S2 Murmur Heart size PBF Percent RAA QRS axis Hypertrophy
D-TGA Single None ↑ ↑ 4 90 to 150 nml 21
TOF Single Systolic Boot ↓ 20 90 to 150 nml 20 to 26
HLHS Single +/- systolic ↑ Venous congestion   90 to 150 ↓ LV forces 16
PA-IVS Single Systolic ↑↑ ↓   30 to 90 LVH, RAE 7
Pulmonary stenosis Single Systolic ↑ ↓   30 to 90 RVH, RAE 7
TAPVC Split Systolic ↑, normal ↑, venous congestion   90 to 150 RAE 6
Tricuspid atresia Single +/- systolic ↑ ↓   -30 to -90 LVH, RAE 6
Truncus arteriosus Single

Systolic +/- diastolic

 ↑ ↑ 30 90 to 150 nml 3
Ebstein Split Systolic ↑↑ ↓   90 to 150 RAE 1
NOTE: This table represents the common presentation of each lesion. Variations do occur. For example, tricuspid atresia usually is associated with a small ventricular septal defect and pulmonary stenosis; some patients with this diagnosis can have a large ventricular septal defect, no pulmonary stenosis, and increased pulmonary blood flow.
S2: second heart sound; PBF: pulmonary blood flow; RAA: right aortic arch; D-TGA: D-transposition of the great arteries; TOF: tetralogy of Fallot; HLHS: hypoplastic left heart syndrome; PA-IVS: pulmonary atresia intact ventricular septum; TAPVC: total anomalous pulmonary venous connection; nml: normal for neonate (right ventricular predominance); LV: left ventricular; LVH: left ventricular hypertrophy; RAE: right atrial enlargement; RVH: right ventricular hypertrophy.
* Incidence from report of New England Regional Infant Cardiac Program. Pediatrics 1980; 65:375.
¶ Patients with TAPVC associated with pulmonary venous observation have normal heart size and venous congestion on the chest radiography, while those without obstruction usually have cardiomegaly and increased pulmonary blood flow.
Graphic 79941 Version 13.0

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